Aberrant regeneration in an international registry of patients with 3rd-nerve palsy

Isdin Oke, Birgit Lorenz, Sotirios Basiakos, Birsen Gokyigit, Erick Laurent, Chong-Bin Tsai, Faruk Orge, Gena Heidary, J Tjeerd H N De Faber, Laila Jeddawi, Mohammed Ali Sadiq, Mitchell Strominger, Mary-Magdalene Ugo Dodd, Ankoor S Shah, Linda R Dagi,

Research output: Contribution to journalArticleResearchpeer-review


Background/Aims To describe the patterns of pre-operative aberrant regeneration and motility outcomes reported in an international registry of patients with 3rd-nerve palsy treated with nasal transposition of the split lateral rectus muscle (NTSLR).

Methods This cross-sectional study used data from an international, multicentre registry of patients with 3rd-nerve palsy treated with NTSLR. Patients with aberrant regeneration were identified, and patterns of innervation described. Demographics and postoperative success defined as horizontal alignment ≤15 PD were compared based on the presence, and type, of aberrant regeneration using Wilcoxon rank sum and Fisher's exact tests.

Results Aberrant regeneration was reported in 16% (21/129) of patients. Age at diagnosis, sex, and aetiology of palsy were not significantly associated with aberrant regeneration. Abnormal movements were triggered by adduction in 52% (11/21), infraduction in 23% (5/21), and supraduction in 23% (5/21) of cases. Presentation patterns involved rectus muscle innervation in 29% (6/21) and levator muscle innervation in 71% (15/21) of cases. Although patients with aberrant regeneration had similar probability of success in comparison to those without following NTLSR (76% vs. 69%, p = 0.5), those with abnormal innervation of a rectus muscle had a lower success rate than those with abnormal innervation of the levator palpebrae superioris muscle (17% vs. 93%; p = 0.002).

Conclusion Successful treatment of a 3rd nerve palsy with NTSLR was not influenced by aberrant regeneration involving the levator muscle. Alternative surgical interventions should be considered when aberrant regeneration alters rectus muscle function given its adverse impact on motor outcomes with NTSLR.
Original languageEnglish
Pages (from-to)2154-2161
Number of pages8
JournalEuropean Journal of Ophthalmology
Issue number6
Early online date9 Mar 2023
Publication statusPublished - Nov 2023


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